__________________________________ Prescription Opioids: Risk Management and Strategies for Safe Use (Percocet), oxycodone (OxyContin tablets), and transdermal fentanyl (Duragesic Transdermal Sys- tem), be flushed down the toilet instead of thrown in the trash [132]. Patients should be advised to flush prescription drugs down the toilet only if the label or accompanying patient information specifically instructs doing so. agency anticipates approval of the modified REMS in 2024 [133]. CONSULTATION AND REFERRAL
It is important to seek consultation or patient referral when input or care from a pain, psychiatry, addiction, or mental health specialist is necessary. Clinicians who prescribe opioids should become familiar with opioid addiction treatment options (including licensed opioid treatment programs for methadone and office-based opioid treatment for buprenorphine) if referral is needed [113]. Ideally, providers should be able to refer patients with active substance abuse who require pain treat- ment to an addiction professional or specialized pro- gram. In reality, these specialized resources are scarce or non-existent in many areas [113]. Therefore, each provider will need to decide whether the risks of continuing opioid treatment while a patient is using illicit drugs outweigh the benefits to the patient in terms of pain control and improved function [24]. MEDICAL RECORDS Documentation is a necessary aspect of all patient care, but it is of particular importance when opi- oid prescribing is involved. All clinicians should maintain accurate, complete, and up-to-date medi- cal records, including all written or telephoned prescription orders for opioid analgesics and other controlled substances, all written instructions to the patient for medication use, and the name, telephone number, and address of the patient’s pharmacy [113]. Good medical records demonstrate that a service was provided to the patient and that the service was medically necessary. Regardless of the treatment outcome, thorough medical records protect the prescriber. DISCONTINUING OPIOID THERAPY The decision to continue or end opioid prescrib- ing should be based on a joint discussion of the anticipated benefits and risks. An opioid should be discontinued with resolution of the pain condition, intolerable side effects, inadequate analgesia, lack of improvement in quality of life despite dose titra- tion, deteriorating function, or significant aberrant medication use [113].
The American College of Preventive Medicine has established the following best practices to avoid diversion of unused drugs and educate patients regarding drug disposal [131]: • Consider writing prescriptions in smaller amounts. • Educate patients about safe storing and disposal practices. • Give drug-specific information to patients about the temperature at which they should store their medications. Generally, the bathroom is not the best storage place. It is damp and moist, potentially resulting in potency decrements, and accessible to many people, including children and teens, resulting in potential theft or safety issues. • Ask patients not to advertise that they are taking these types of medications and to keep their medications secure. • Refer patients to community “take back” services overseen by law enforcement that collect controlled substances, seal them in plastic bags, and store them in a secure location until they can be incinerated. Contact your state law enforcement agency or visit https://www.dea.gov to determine if a program is available in your area. In April 2023, the FDA announced it will require manufacturers of opioid analgesics dispensed in outpatient settings to make prepaid mail-back envelopes available to outpatient pharmacies and other dispensers as an additional opioid analgesic disposal option for patients. The REMS modi- fication also requires manufacturers to develop educational materials for patients on safe disposal of opioid analgesics, which outpatient pharmacies and other dispensers may provide to patients. The
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MDMS1526
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